Insurance

Important Notice

Effective November 17, 2021 Springfield Clinic will be out of network with Blue Cross Blue Shield of Illinois PPO. Below are some Frequently Asked Questions as to the impact this will have with you should you seek services with Memorial Health.

What does it mean that Springfield Clinic providers are out of network for Blue Cross and Blue Shield of Illinois (BCBS) PPO members?

Springfield Clinic and BCBS were unable to reach a contract agreement by the Nov. 17, 2021, deadline. As a result, Springfield Clinic is now out of network for BCBS PPO members. This means that members who receive care from Springfield Clinic providers may pay more for that care through higher coinsurances and deductibles, as well as a practice called balance billing in which any amount charged by Springfield Clinic for services not covered by insurance may be billed back to the member.

Why might I get an out-of-network bill when I am at an in-network facility?

All Memorial Health locations remain in-network with BCBS PPO. However, there are many Springfield Clinic providers who work in our hospitals and facilities. The portion of your care provided by Memorial Health will be processed at the lower in-network rates, while the portion of your care provided by Springfield Clinic personnel may be processed at the higher out-of-network rate.

If a Springfield Clinic physician interprets a test I received at a Memorial Health location, will it be billed as in network or out of network?

Professional services rendered by a Springfield Clinic provider, including interpretation of a test received at a Memorial Health facility location, would be considered out of network and may be balance billed. This is because those professional services are billed by Springfield Clinic, not Memorial Health. However, there is an exception for services provided by a Springfield Clinic radiologist. Memorial’s contract with the radiology group prohibits Springfield Clinic from balance billing for services rendered to patients who received their test at a Memorial Health facility.

How much will my out-of-network care cost?

Because insurance plans and billing rates differ, you will need to contact Springfield Clinic and/or Blue Cross and Blue Shield of Illinois for this information. You can call 217-528-7541 to request a cost estimate for your specific situation from Springfield Clinic. Call the number on the back of your insurance card to discuss this situation with BCBS.

Can I transfer my care to an in-network provider?

If you are a patient at Memorial Health hospital, we will make sure you are aware if you may receive care from a Springfield Clinic provider. We will help transfer your care to an in-network provider if feasible. You may learn more about in-network providers by visiting bcbsil.com or calling BCBS at the number listed on your insurance card.

Will my services received at a Memorial facility be considered in-network if ordered by a Springfield Clinic provider?

Yes. Ordered services, even from an out-of-network Springfield Clinic provider, will be considered in-network when rendered at a Memorial Health facility. Examples of services that would fall into this situation include labs, imaging, physical/occupational/speech therapy and rehab. This is due to the fact that Memorial Health is in-network with BCBS PPO and will bill for those services – not Springfield Clinic.

No Surprises Act protections

Effective January 1, 2022, you will be protected from being balanced billed by out of network providers in emergency situations. For non-emergency situations, you must agree and consent to being balanced billed by the out of network provider. Please visit our No Surprises Act page for additional information.

Memorial Health affiliates proudly accept a wide variety of health insurance plans to serve our community. The list provided below includes plans that each affiliate is currently participating. We encourage all patients to verify coverage and benefits with their plan administrator or insurance carrier.

Can't find your health plan?

If you do not see your health plan listed, please contact the Memorial Health Managed Care Department at 217-788-4448 or via email at ManagedCareDepartment@mhsil.com.

Below are links to common insurance plans accepted at Memorial Health. While we cannot quote benefits or coverage, we hope these links can help direct you to your insurance payor for the information you require. 

Hospital Facilities

Decatur Memorial Hospital

Note: Independent health care providers who practice at Decatur Memorial Hospital may not be participating in the same insurance plans and networks as Decatur Memorial Hospital. Independent providers’ services will be billed separately.

Commercial Insurance Plans

  • Aetna/Coventry
  • Amish-Mennonite
  • BlueCross BlueShield of Illinois HMO/PHAI (Site 314)
  • BlueCross BlueShield of Illinois PPO (Blue Distinction Center)

Blue Distinction® Center and Blue Distinction® Center + Designations: Hip and Knee Replacement + and Maternity Care +

What is a Blue Distinction Center? According to BlueCross BlueShield of Illinois, there are two levels of recognition. Blue Distinction Centers offer quality care, treatment expertise and better overall patient results. Blue Distinction Centers + offer more affordable care in addition to quality care, treatment expertise and better overall patient results.

Center of Excellence Designations: Cardiac Catheterization and Angioplasty, and Colon Surgery

What is a Center of Excellence? According to Cigna, a center of excellence is a designation is obtained after review. This review is based on two key things: patient outcomes, or how successful a hospital is at caring for patients undergoing a certain surgery or being treated for an illness, and cost-efficiency—the hospital's ability to deliver consistently excellent patient care while still keeping costs lower than average.

  • Consociate Group
  • CorVel
  • Health Alliance
  • HealthLink
  • Humana
  • MultiPlan/PHCS (Physician-only plans not accepted)
  • Plain Church Medical Group
  • United Healthcare (Physician-only plans not accepted)

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part A & B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross BlueShield of Illinois 
  • Health Alliance Basic 
  • HumanaChoice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Illinois Traditional Medicaid

Medicaid Managed Care Plans (HealthChoice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicare Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete
  • Molina Healthcare

Service Member Plans

  • Tricare/Humana Military
  • VA Community Care Network (VA CCN)

Lincoln Memorial Hospital

Note: Independent health care providers who practice at Lincoln Memorial Hospital may not be participating in the same insurance plans and networks as Lincoln Memorial Hospital.  Independent providers’ services will be billed separately.

Commercial Insurance Plans

  • Aetna/Coventry
  • BlueCross BlueShield of Illinois HMO/PHAI (Site 314)
  • BlueCross BlueShield of Illinois PPO
  • Caterpillar, Inc
  • Cigna PPO
  • Consociate Group
  • CorVel
  • Health Alliance
  • HealthLink
  • HFN
  • Humana
  • Multiplan/PHCS (Physician-only plans not accepted)
  • United Healthcare (Physician-only plans not accepted)

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part A & B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross BlueShield of Illinois
  • Health Alliance Basic 
  • HumanaChoice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Illinois Traditional Medicaid

Medicaid Managed Care Plans (HealthChoice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicare Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete

Service Member Plans

  • Tricare/Humana Military
  • VA Community Care Network (VA CCN)

Jacksonville Memorial Hospital

Note: Independent health care providers who practice at Jacksonville Memorial Hospital may not be participating in the same insurance plans and networks as Jacksonville Memorial Hospital. Independent providers’ services will be billed separately.

Commercial Insurance Plans

  • Aetna/Coventry
  • BlueCross BlueShield of Illinois HMO/PHAI (Site 314)
  • BlueCross BlueShield of Illinois PPO (Blue Distinction Center)

Blue Distinction® Center and Blue Distinction® Center + Designations: Hip and Knee Replacement and Maternity Care

What is a Blue Distinction Center? According to BlueCross BlueShield of Illinois, there are two levels of recognition. Blue Distinction Centers offer quality care, treatment expertise and better overall patient results. Blue Distinction Centers + offer more affordable care in addition to quality care, treatment expertise and better overall patient results.

Center of Excellence Designations: Delivery (C-Section, Vaginal Delivery) and Respiratory Conditions

What is a Center of Excellence? According to Cigna, a center of excellence is a designation is obtained after review. This review is based on two key things: patient outcomes, or how successful a hospital is at caring for patients undergoing a certain surgery or being treated for an illness, and cost-efficiency—the hospital's ability to deliver consistently excellent patient care while still keeping costs lower than average.

  • CorVel
  • Current Health Network
  • Health Alliance
  • HealthLink
  • HFN
  • Humana Health Plan
  • MultiPlan/PHCS (Physician-only plans not accepted)
  • United Healthcare (Physician-only plans not accepted)

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part A & B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross BlueShield of Illinois 
  • Health Alliance Basic
  • HumanaChoice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Illinois Traditional Medicaid

Medicaid Managed Care Plans (HealthChoice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicare Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete

Service Member Plans

  • Tricare/Humana Military
  • VA Community Care Network (VA CCN)

Springfield Memorial Hospital

Note: Independent health care providers who practice at Springfield Memorial Hospital may not be participating in the same insurance plans and networks as Springfield Memorial Hospital. Independent providers’ services will be billed separately.

Commercial Insurance Plans

  • Aetna/Coventry
  • BlueCross BlueShield of Illinois HMO/PHAI (Site 314)
  • BlueCross BlueShield of Illinois PPO (Blue Distinction Center)

Blue Distinction® Center and Blue Distinction® Center + Designations: Cardiac Care +, Spine Surgery +, Bariatric Surgery +, Hip and Knee Replacement

What is a Blue Distinction Center? According to BlueCross BlueShield of Illinois, there are two levels of recognition. Blue Distinction Centers offer quality care, treatment expertise and better overall patient results. Blue Distinction Centers + offer more affordable care in addition to quality care, treatment expertise and better overall patient results.

Center of Excellence Designations: Bariatric Surgery, Cardiac Catheterization and Angioplasty, and Gallbladder Removal, Laparoscopic

What is a Center of Excellence? According to Cigna, a center of excellence is a designation is obtained after review. This review is based on two key things: patient outcomes, or how successful a hospital is at caring for patients undergoing a certain surgery or being treated for an illness, and cost-efficiency—the hospital's ability to deliver consistently excellent patient care while still keeping costs lower than average.

  • Consociate Group
  • CorVel
  • Current Health Network
  • Health Alliance
  • HealthLink
  • HFN
  • Humana
  • MultiPlan/PHCS (Physician-only plans not accepted)
  • Preferred Plan, Inc.
  • United Healthcare (Physician-only plans not accepted)

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part A & B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross BlueShield of Illinois 
  • Health Alliance Basic 
  • Humana Choice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Illinois Traditional Medicaid

Medicaid Managed Care Plans (Health Choice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicare Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete

Service Member Plans

  • Tricare/Humana Military
  • VA Community Care Network (VA CCN)

Taylorville Memorial Hospital

Note: Independent health care providers who practice at Taylorville Memorial Hospital may not be participating in the same insurance plans and networks as Taylorville Memorial Hospital. Independent providers’ services will be billed separately.

Commercial Insurance Plans

  • Aetna/Coventry
  • BlueCross BlueShield of Illinois HMO/PHAI (Site 314)
  • Blue Cross Blue Shield of Illinois PPO
  • Caterpillar, Inc
  • Cigna PPO
  • Consociate Group
  • CorVel
  • Health Alliance
  • HealthLink
  • HFN
  • Humana Health Plan
  • MultiPlan/PHCS (Physician-only plans not accepted)
  • United Healthcare (Physician-only plans not accepted)
  • United Mine Workers of America (UMWA)

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part A & B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross BlueShield of Illinois 
  • Health Alliance Basic
  • HumanaChoice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Illinois Traditional Medicaid

Medicaid Managed Care Plans (HealthChoice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicare Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete

Service Member Plans

  • Tricare/Humana Military
  • VA Community Care Network (VA CCN)

Ambulatory Providers

Memorial Care

Note: Memorial Medical Group sites of care are recognized by the National Committee for Quality Assurance (NCQA) as patient-centered medical homes. This model of care puts you and your loved ones at the center of care by enhancing communication, better coordinating your needed care and a continuous commitment to quality improvement. For those seeking Urgent Care services through Memorial Care, please note that Memorial Care bills these services with an office, not urgent care, place of service. Please consult with your benefits to learn more as to the impact of this designation.

Commercial Insurance Plans

  • Aetna/Coventry
  • BlueCross BlueShield of Illinois HMO/PHAI (Site 314)
  • BlueCross BlueShield of Illinois PPO
  • Cigna PPO
  • Consociate Group
  • CorVel
  • Health Alliance
  • HealthLink
  • HFN
  • Humana Health Plan
  • Multiplan/PHCS
  • United Healthcare

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part A & B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross Blue Shield of Illinois
  • Health Alliance
  • HumanaChoice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Illinois Traditional Medicaid

Medicaid Managed Care Plans (HealthChoice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicaid Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete

Service Member Plans

  • VA Community Care Network (VA CCN)

DMH Medical Group

Note: DMH Medical Group sites of care are recognized by the National Committee for Quality Assurance (NCQA) as patient-centered medical homes. This model of care puts you and your loved ones at the center of care by enhancing communication, better coordinating your needed care and a continuous commitment to quality improvement.

Commercial Insurance Plans

  • Aetna/Coventry
  • Amish-Mennonite
  • BlueCross BlueShield of Illinois HMO
  • BlueCross BlueShield of Illinois PPO
  • Caterpillar, Inc
  • Cigna PPO
  • Consociate Group
  • CorVel
  • Health Alliance
  • HealthLink
  • Humana
  • MultiPlan/PHCS (Physician-only plans not accepted)
  • Plain Church Medical Group
  • United Healthcare (Physician-only plans not accepted)

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part A & B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross BlueShield of Illinois 
  • Health Alliance Basic 
  • HumanaChoice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Illinois Traditional Medicaid

Medicaid Managed Care Plans (HealthChoice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicaid Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete
  • Molina Healthcare

Service Member Plans

  • Tricare/Humana Military
  • VA Community Care Network (VA CCN)

Memorial Wellness Center

We will work with you to verify insurance coverage, discuss payment options and answer general questions after completion of your online orientation. Each provider and plan is different, so we are here to provide individual consultation about your specific coverage.

If you have questions, please do not hesitate to contact us. This includes your initial quote, the addition of other diagnoses to your quote, what is covered and not covered, as well as discounted rates.

We are here to help you navigate this process and achieve a healthier lifestyle.

Medicaid Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete

Memorial Behavioral Health 

Commercial Insurance Plans

  • BlueCross BlueShield of Illinois HMO/PHAI (Site 314)
  • BlueCross BlueShield of Illinois PPO
  • CorVel
  • Health Alliance
  • HealthLink
  • Magellan
  • MultiPlan/PHCS

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross BlueShield of Illinois
  • Health Alliance Basic
  • HumanaChoice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Traditional Illinois Medicaid

Medicaid Managed Care Plans (HealthChoice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicaid Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete

Service Member Plans

  • Tricare/Humana Military
  • VA Community Care Network (VA CCN)

Memorial Home Care

Commercial Insurance Plans

  • Aetna/Coventry
  • BlueCross BlueShield of Illinois HMO/PHAI (Site 314)
  • BlueCross BlueShield of Illinois PPO
  • Cigna PPO
  • Consociate Group
  • CorVel
  • Health Alliance
  • HealthLink
  • Humana Health Plan
  • Multiplan/PHCS
  • Preferred Plan, Inc

ACA/Exchange Plans

Medicare

  • Traditional Medicare Part A & B

Medicare Advantage Managed Care (Part C) Plans

  • Aetna/Coventry Advantra
  • BlueCross Blue Shield of Illinois 
  • Health Alliance
  • HumanaChoice
  • United HealthCare (effective February 1, 2023)
  • WellCare

Medicaid

  • Illinois Traditional Medicaid

Medicaid Managed Care Plans (HealthChoice Illinois)

  • Aetna Better Health of Illinois (previously IlliniCare)
  • Blue Cross Community Health Plans
  • Meridian Health
  • Molina Healthcare

Medicare Managed Care Plans (Medicare-Medicaid Alignment)

  • Blue Cross Community Health
  • MeridianComplete

Service Member Plans

  • VA Community Care Network (VA CCN)

Affordable Care Act (ACA)

    As a provision of the Affordable Care Act (ACA), uninsured Americans can enroll in insurance plans through the Health Insurance Marketplace. In Illinois, the health insurance marketplace is named “Get Covered Illinois”.
  • The Insurance marketplace is designed to help uninsured persons find a health insurance plan in their area that fits their needs and budget. The marketplace also helps determine if applicant qualify for Medicaid coverage.
  • Memorial Health participates in many options offered through the marketplace.
  • Visit GetCoveredIllinois.gov or Healthcare.gov or call 800-318-2596 to get more information on enrolling.
  • In-person counselors, or navigators, are available to assist with enrollment at no cost at a number of social service agencies in Central Illinois, including:

Visit GetCoveredIllinois.gov for more information and resources.

Springfield Area

Illinois Stewardship Alliance
230 Broadway St. I 217-720-0453

Springfield Urban League
100 N. 11th St. | 217-522-0407, ext. 1451

Family Guidance Centers
120 N. 11th St. | 855-328-6392

Central Counties Health Centers
2239 E. Cook St. | 217-788-2300

SIU Center for Family Medicine
520 N. Fourth St. | 217-545-8000

Sangamon County Department of Public Health
2833 South Grand Ave. E. | 217-535-3100

Decatur Area

Macon County Department of Public Health
1221 E. Condit St I 217-423-6988

Crossing HealthCare
320 Central Ave I 217-877-9117

SIU Center for Family Medicine
102 W. Kenwood Ave I 217-872-3800

Jacksonville Area

Jacksonville Area Center for Independent Living
15 Permac Road | 217-245-8371

Morgan County Health Department
345 W. State St. | 217-245-5111

Taylorville Area

Christian County Department of Public Health
902 W. Springfield Road | 217-824-4113

Contact Us